Sarah Wovcha, J.D., M.P.H.

American Association for Community

Dental Programs Symposium

Fort Worth, TX

April 25, 2014

Funded by MCHB and HRSA

Integrate comprehensive oral health services

into an existing school-based health center

(SBHC); within Schools, Head Start Centers and

Community Centers

Increase access to oral health care

Assure delivery of quality education and preventive

and restorative care

Targeted to children and adolescents from

underserved populations, immigrant and refugee

community, and at-risk for oral disease.

Mission:

Children's Dental Services is dedicated to improving the oral health of children from families with low incomes by providing accessible treatment and education to our diverse community.

Began in 1919 as a women’s charity that

supported the provision of oral health care

services to orphans living in Minneapolis

Became the first provider of Head Start-

based oral health care in the United States in

the 1960s

Quadrupled in size since 2000 due to lack of

access to affordable dental care for low-

income children and families

Is currently the single largest provider of on-

site oral health care in Minnesota schools and

Head Start programs

Children from birth to

age 21

Pregnant women with

low incomes

Individuals with low

incomes, the uninsured,

and the under-insured

Individuals with special

health care needs

Individuals who are

chemical and alcohol

dependent

Homeless individuals

and families

Members of the

gay/lesbian/bisexual/tr

ansgender community

Racial and ethnic

individuals including

those from East Africa,

Central and South

America, Southeast

Asia, and Native

American communities

Outreach

Oral health education

Preventive oral health

care (prophylaxis,

fluoride, sealants)

Restorative care

(restorations, extractions,

pulpotomies, stainless

steel crowns, and root

canals)

Hospital care, if needed

25%24%

22%

14%

10%

5%

0%

5%

10%

15%

20%

25%

30%

Somali/East

Africa

Latino African America Caucasian Hmong American Indian

Language fluency: CDS staff

speak over 16 different

languages and hail from 20

countries

Representing cultures

served: Understanding the

cultural norms, religious

needs and diets of target

communities staff create

culturally targeted and

translated curriculum for

care in school-based settings

Children and pregnant women go without needed services

Insurance Status

Shortage of

Providers

Language Barriers

Providing portable oral health care services

at SBHCs, Schools, Community Centers and

Head Start Centers

Decreasing multiple barriers affecting

families’ with low incomes access to oral

health care

Serving as a model for delivery of school-

based oral health care services for other

Minnesota cities

Minneapolis: 65.8% of residents are of a race or ethnicity other than

European American

69% of students are enrolled in free and reduced lunch

program

Family income is <185% of federal poverty guidelines

Edison High School (where CDS provides Care)

89.1% of students are of a race or ethnicity other than

European American 61.1%: African American

16.7%: Hispanic American

8.5%: Asian American

2.8%: American Indian

92.4% are enrolled in free and reduced lunch program

Engaging Refugee and Immigrant

Communities

Staff is representative of refugee and

immigrant community

Multiple languages offered

Provide care in a location

where trust is established

Reduce economic barriers

“One important means to

promote oral health in

diverse populations is to

develop a workforce that

is both culturally and

linguistically competent,

as well as one that is as

culturally diverse as the

American population.”

Garcia R, Cadoret C, Henshaw M. 2007. Multicultural issues in oral health. Dental Clinics of North

America 52(2):319–332.

Patients feel comfort and trust in staff who:

• Understand from where they come

• Understand their cultural norms and language

CDS acknowledges the

need to speak the same

language as their patients

Staff offer verbal and

written communication in:

Somali

Spanish

Hmong

Karen

Oromo

Clinical settings can

be intimidating

Families know and

trust in the

education system

No additional

transportation

requiredCDS provides on-site

care in elementary

schools

Number of African-born residents in MN

increased by 580% between 1990 and 2000

By 2002, ~9,000 immigrants arrived in MN

directly from various African nations.

13% of MN’s foreign-born residents are from

Africa.

Most came as refugees from Liberia, Somalia,

and the Sudan.

Recent immigrants arriving from Nigeria,

Ethiopia, and Eritrea.

MN has the largest population of Somali

residents in the U.S.

Most Somalis live in the Minneapolis metro

area. Fewer numbers live in Rochester,

Owantonna, and other suburban and greater

MN communities.

Nearly 1/3 of student who speak Somali at

home attend Minneapolis public schools.

Somalis immigrants are diverse; coming

from urban, coastal, agricultural and/or

nomadic regions.

“Children in non-English-primary-language

households are significantly more likely than

children in English-primary-language

households to be poor (42% vs 13%)”.

CDS Offers:

Coordinated assistance for families applying for

Medical Assistance

Certified MNCAA agents can assist families and submit

insurance application on behalf of eligible families

Flores G, Tomany-Korman SC. 2008. The language spoken at home and disparities in medical and dental health, access to

care, and use of services in US children. Pediatrics 121(6):e1703–1714.

60% of students served by

CDS are African, including

those who self-identify as

East African.

East African immigrants do

not place high importance

on oral health and

preventive health.*

* Obeng CS. 2008. Dental care issues for African immigrant families of preschoolers. Early Childhood

Research and Practice 10(2).

Dental checkups are not the cultural norm

Caries is not considered a health issue

Impact of refugee camps

Poor diet

Limited or no access to oral health care

History of torture

Effective oral health practices that are

not the norm in the U.S. (e.g., brushing

with the miswak)

Lack access to preventive and

restorative oral health care

Inadequate or no interpretative

services in dental care settings

Unfamiliar with the dangers of

western diet on oral health (e.g., high

sugar in food and drink)

Potentially unfamiliar with tooth

brushing and flossing

Flores G, Tomany-Korman SC. 2008. The language spoken at home

and disparities in medical and dental health, access to care, and

use of services in US children. Pediatrics 121(6):e1703–1714.

Garcia R, Cadoret C, Henshaw M. 2007. Multicultural issues in oral

health. Dental Clinics of North America 52(2):319–332.

Obeng CS. 2008. Dental care issues for African immigrant families

of preschoolers. Early Childhood Research and Practice 10(2).

Minneapolis Public Schools. 2010–2011. Report of the Annual

Racial/Ethnic Count of MPS Students for the 2009–2010 Year.

Minneapolis, MN: Minneapolis Public Schools

Minneapolis Public Schools. 2010–2011. Minnesota Department of

Education Count for Compensatory Revenue—Meal Participation.

Minneapolis, MN: Minneapolis Public Schools.

Minneapolis Department of Health & Family Support. 2011.

Students Enrolled in Seven Minneapolis High Schools.

Sarah Wovcha, J.D., M.P.H.

Executive Director

In-House Counsel

Children’s Dental Services

(612) 636-1577

swovcha@childrensdentalservices.org